011315 cirrhosis Flashcards
cirrhosis etiologies
hep B (D), hep C, alcohol, hemochromatosis, Wilson’s disease, non-alcholic steatohepatitis, primary biliary cirrhosis, primary sclerosing cholangitis, autoimmune hepatitis, alph-1 antitrypsin deficiency, Budd chiari syndrome
cirrhosis–examination findings
cachexia (muscle loss), jaundice, ascites, spider angioma, Dupuytren’s contractures, pitting edema, breast development, testicular atrophy, palmar erythema, hair loss, encephalopathy
lab findings for cirrhosis
elevated bilirubin elevated transaminases elevated alkaline phosphatase decreased albumin elevated PT/INR thrombocytopenia leukopenia renal insufficiency hyponatremia
spider angioma differential
advanced liver disease or pregnancy
due to estrogen levels
chronic cirrhosis-CT?
liver shrunken
spleen enlarged
Child Pugh scoring criteria
assess degree of cirrhosis with subjective and objective factors
to assess to see if needs liver transplant
what is used instead of Child Pugh now
model for end stage liver disease (MELD)–used b/c Child Pugh has subjective factors
Budd Chiari
hepatic vein thrombosis
leads to portal HTN
complications of cirrhosis
variceal bleed ascites spontaneous bacterial peritonitis (ascites becomes infected) hepatorenal syndrome hepatopulm syndrome hepatic encephalopathy
when spleen enlarges, what happens?
sequesters platelets and WBCs
thrombocytopenia, leukopenia
to prevent variceal bleeds (for pt with varices that haven’t bled yet), what tx do you give
beta adrenergic blockers (non-selective beta blockers):
propranolol
nadolol
bleeding esophageal varices show what symptoms
vomiting black blood
melena
tx for active variceal hemorrhage
octreotide (decreases amt of blood coming into the portal vein)
band ligation
how does hyponatremia result from cirrhosis?
cirrhosis causes portal HTN, splachnic arterial vasodilatation, decreased effective circulating volume, activation of vasoconstrictor and antinatriuretic factors, more water retention than sodium retention
tx of ascites
2000 mg sodium restricted diet
diuretics (spironolactone to inhibit aldosterone, furosemide)
signs and symptoms in pts with spontaneous bacterial peritonitis
abdominal pain
fever
encephalopathy
pathogenesis in spontaneous bacterial peritonitis
E coli
Strep
mostly gram negative
in hepatorenal syndrome, what happens to kidney?
vasoconstriction
in hepatorenal syndrome, what happens to urine sodium? urine micro? central venous pressure?
urine sodium is under 10 mEq/L
urine micro is normal
central venous pressure is low
does hydration tx hepatorenal syndrome?
no
tx for hepatopulm syndrome?
only tx is to relieve vasodilated state, meaning:
only way would be to get new liver
pathophysiology of hepatic encephalopathy
gut derived neurotoxins can no longer be processed by liver due to hepatic insufficiency or hepatic bypass in portal HTN, so they cross the BBB
what symptoms can you see with encephalopathy
asterixis
squeeze finger test-cannot maintain tone
tx for enchalopathy
lactulose (decreases pH and converts NH3 to NH4)
rifaximin (antibiotic)
causes of ACUTE liver failure in the US
acetaminophen toxicity drugs hep B pregnancy etc
fulminant liver failure
acute liver failure with hepatocyte necrosis (causing coagulopathy, encephalopathy)
cerebral edema (inability of liver to metabolize ammonia. ammonia converted into glutamine by brain astrocytes, leading to astrocyte swelling). LEADING CAUSE OF DEATH
hepatorenal syndrome is compliciation of
ascites
the three complications of ascites
SBP
hepatorenal syndrome
hyponatremia
